Categories
Chemotherapeutic Agents Nursing Pharmacology

Immune Modulators

Immune Modulators

 

Sites of Actions of Immune Modulators

  • Immune modulators
    • Modify the actions of the immune system
  • Immune stimulants
    • Energize the immune system when it needs help fighting a specific pathogen
  • Immune suppressants
    • Block the normal effects of the immune system in organ transplantation and autoimmune disorders

Immune Stimulants

  • Interferons
    • Naturally released from human cells in response to viral invasion
  • Interleukins
    • Communicate between lymphocytes, stimulate cellular immunity, and inhibit tumor growth
  • T and B cell modulator (levamisole)
    • Restores immune function and activity

Interferon

  • Actions
    • Prevents virus particles from replicating inside other cells
    • Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
    • Inhibits tumor growth and replication
  • Pharmacokinetics
    • Absorbed well after subcutaneous or intramuscular injection
    • Broken down in the tissues
    • Excreted in the kidneys
    • May be teratogenic
  • Contraindications
    • Known allergy
    • Pregnancy and lactation
    • Use with caution in cardiac disease, myelosuppression, and with central nervous system dysfunction
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, anorexia, nausea, headache, dizziness, and bone marrow depression
  • Drug-to-drug interactions

Interleukins

  • Definition
    • Chemicals produced by T cells to communicate between leukocytes
  • Types of preparations
    • Aldesleukin (Proleukin)
      • Human interleukin produced by recombinant DNA technology using Escherichia coli bacteria
    • Oprelvekin (Neumega)
      • A newer agent produced by DNA technology
  • Actions
    • Increase the number of natural killer cells and lymphocytes
    • Activate cellular immunity and inhibit tumor growth
  • Indications
    • Aldesleukin: specific renal carcinomas and possible treatment of AIDS and AIDS-related disorders
    • Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy
  • Pharmacokinetics
    • Rapidly distributed after injection
    • Cleared by the kidneys
    • Teratogenic
  • Contraindications
    • Known allergy, pregnancy, and lactation
    • Caution with renal, liver, or cardiovascular impairment
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, fatigue, fever, and respiratory difficulties

T and B Cell Modulators

  • Action/Indication
    • Levamisole stimulates B cells which in turn stimulate antibody formation, enhancing T cell activity
    • Used in the treatment of Duke’s stage C colon cancer
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peaks in 1.5 to 2 hours
    • Metabolized in the liver and excreted in the urine
    • T½ of 16 hours
  • Contraindications
    • Known allergy, pregnancy, and lactation
  • Adverse reactions
    • Headache, dizziness, ataxia, nausea, vomiting, and diarrhea
  • Drug-to-drug interactions
    • Disulfiram-type reaction
    • Increased phenytoin levels

Types of Immune Suppressants

  • T and B cell suppressors
  • An interleukin receptor antagonist
  • Monoclonal antibodies
    • Produced by a single clone of B cells that react with specific antigens

T and B Cell Suppressors

  • Azathioprine (Imuran): prevents rejection in renal hemotransplants; treats rheumatoid arthritis
  • Cyclosporine (Sandimmune): suppresses rejection in a variety of transplants; treats rheumatoid arthritis and psoriasis
  • Glatiramer acetate (Copaxone): reduces number of relapses in multiple sclerosis in adults
  • Mycophenolate mofetil (CellCept): prevents rejection after renal or heart transplant in adults
  • Sirolimus (Rapamune): prevents rejection after renal transplantation
  • Tacrolimus (Prograf): prevents rejection after liver transplantation
  • Action
    • Inhibit DNA synthesis
  • Contraindications
    • Known allergy, pregnancy, CNS disease, and hepatic disease
  • Drug-to-drug interactions

T and B Cell Suppressor Adverse Effects

  • Increased risk for infection and development of neoplasms
  • Hepatotoxicity
  • Renal toxicity and renal dysfunction
  • Pulmonary edema
  • Possible headache, tremors, and secondary infections such as acne, GI upset, diarrhea, and hypertension

Interleukin Receptor Antagonists

  • Actions
    • Used to treat rheumatoid arthritis
    • Block activity of interleukin-1
  • Pharmacokinetics
    • Given subcutaneously
    • Reach peak in 3 to 7 hours
    • Metabolized in the tissues
    • T½ of 4 to 6 hours
  • Contraindications
    • Known allergy, pregnancy, lactation, and renal impairment
  • Adverse reactions
    • Headache, sinusitis, nausea, and diarrhea
  • Drug-to-drug interaction
    • Etanercept may cause severe and even life- threatening infections

Monoclonal Antibodies

  • Action
    • Antibodies attach to specific receptors
  • Pharmacokinetics
    • Must be injected
  • Contraindications
    • Known allergy and fluid overload
  • Adverse reactions
    • Pulmonary edema, fluid retention, flu-like symptoms
  • Drug-to-drug interaction
    • Severe immune suppression can occur

Use of Immune Modulators Across the Lifespan

Use of Immune Modulators Across the Lifespan
Use of Immune Modulators Across the Lifespan

Prototype Immune Stimulants

Prototype Immune Stimulants
Prototype Immune Stimulants

Prototype Interleukins

Prototype Interleukins
Prototype Interleukins

Prototype T and B Cell Suppressors

Prototype T and B Cell Suppressors
Prototype T and B Cell Suppressors

Prototype Monoclonal

Prototype Monoclonal
Prototype Monoclonal

Nursing Considerations for Immune Stimulators

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Immune Suppressants

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Chemotherapeutic Agents Nursing Pharmacology

Antineoplastic Agents

Antineoplastic Agents

Neoplasm Cancer—Mechanisms of Growth

  • Anaplasia
    • Cancerous cells lose cellular differentiation and organization and are unable to function normally
  • Autonomy
    • Cancerous cells grow without the usual homeostatic restrictions that regulate cell growth and control
    • This allows the cells to form a tumor
  • Metastasis
    • Cancer cells travel from the place of origin to develop new tumors in other areas of the body
  • Angiogenesis
    • Abnormal cells release enzymes to generate blood vessels and supply oxygen and nutrients to the cells, generating growth
    • Cancerous cells rob the host cells of energy and nutrients and block normal lymph

The Body’s Immune System Response to Cancerous Cells

  • Can damage or destroy some neoplastic cells
  • T cells recognize the abnormal cells and destroy them
  • Antibodies form in response to parts of the abnormal cell protein
  • Interferons and tissue necrosis factor (TNF) play a role in the body’s attempt to eliminate the abnormal cells

Possible Causes of Cancer

  • Genetic predisposition
  • Viral infection
  • Constant irritation and cell turnover
  • Stress
  • Lifestyle factors
  • Environmental factors

Classifications of Tumors

  • Solid tumors
    • May originate in any body organ
    • Carcinomas (originate in epithelial cells)
    • Sarcomas (originate in the mesenchyma)
  • Hematologic malignancies
    • Leukemias and lymphomas that occur in the blood-forming organs

Mechanisms of Antineoplastic Drugs

  • Affect cell survival
  • Boost the immune system in its efforts to combat the abnormal cells

Goal of Cancer Treatment

  • To destroy cancer cells using the following methods:
    • Surgical removal
    • Stimulation of the immune system to destroy them
    • Radiation therapy to destroy them
    • Drug therapy to kill them during various phases of the cell cycle

Categories of Antineoplastic Agents

  • Alkylating agents
    • React chemically with portions of the RNA, DNA, or other cellular proteins
  • Antimetabolites
    • Have chemical structures similar to those of natural metabolites
  • Antineoplastic antibiotics
    • Not selective for bacterial cells only; toxic to human cells
  • Mitotic inhibitors
    • Drugs that kill cells as the process of mitosis begins
  • Hormones and hormone modulators
    • Used in cancers that are sensitive to estrogen stimulation
  • Cancer-cell–specific agents
    • Treat chronic myeloid leukemia (CML) and CD117-positive unresectable or metastatic malignant GI stromal tumors (GIST)

Sites of Action of Non-Cell-Cycle–Specific Antineoplastic Agents

Sites of Actions of Non-Cell-Cycle-Specific Antineoplastic Agents
Sites of Actions of Non-Cell-Cycle-Specific Antineoplastic Agents

 

 

Sites of Action of Cell-Cycle–Specific Antineoplastic Agents

Sites of Action Cell-Cycle-Specific Antineoplastic Agents
Sites of Action Cell-Cycle-Specific Antineoplastic Agents

Alkylating Agents

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Antimetabolites

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Antineoplastic Antibiotics

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Mitotic Inhibitors

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Hormones and Hormone Modulators

  • Actions
  • Pharmacokinetics
  • Contraindications
  • Adverse reactions
  • Drug-to-drug interactions

Prototype Alkylating Agent

Prototype Alkylating Agent
Prototype Alkylating Agent

 

 

Prototype Antimetabolite Agent

Prototype Antimetabolite Agent
Prototype Antimetabolite Agent

 

 

Prototype Antineoplastic Antibiotics

Prototype Antineoplastic Antiboitics
Prototype Antineoplastic Antiboitics

 

 

Prototype Mitotic Inhibitors

Prototype Mitotic Inhibitors
Prototype Mitotic Inhibitors

 

Prototype Hormones and Hormone Modulators

Prototype Hormones and Hormone Modulators
Prototype Hormones and Hormone Modulators

 

 

Use of Antineoplastic Across the Lifespan

Use of Antineoplastic Across the Lifespan
Use of Antineoplastic Across the Lifespan

 

 

Nursing Considerations for Alkylating Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antimetabolites

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antineoplastic Antibiotics

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Mitotic Inhibitors

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Hormones and Hormone Modulators

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation